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Addiction and Substance Abuse

Long-term effects of crack

03/06/2006

Question:

I was wondering if you could tell if crack has long term effects after youve quit

Answer:

Cocaine use can lead to long-term effects on various organ systems, many of which can be treated if you tell your health care provider you have used crack. Cocaine also has long-term effects on behavior.

Brain effects:

Even after months of abstaining, people who have used cocaine for a long time can have problems thinking, such as memory, attention, problem solving, and use of words. They can also have problems with hand-eye coordination.

Cocaine use can cause people to be paranoid and to hallucinate. Some will have flashbacks for years.

Scans of the brain have shown decreases in size and loss of cells and loss of connections between cells even after abstinence.

Brain damage can be caused by strokes. If a person has had complicated seizures while using cocaine, there is the possibility of long-term brain damage.

Heart and Blood Vessel effects:

Cocaine narrows blood vessels by stimulating the muscles of the vessels. It also causes narrowing of vessels by increasing atherosclerosis. Cocaine makes the heart beat faster both in an organized way and a disorganized way (arrhythmia). Fast heart rates can be less efficient at supplying heart muscle with blood and oxygen, leading to heart attacks and strokes. Cocaine users are 7 times more likely to have a nonfatal heart attack than non-users.

Cocaine also directly damages heart muscle in 20-50% of users. This results in heart muscle that is not as strong or effective in pumping blood. Even after stopping cocaine use, the results of the damage to heart and brain can continue.

Lung effects:

Smoking crack causes a lung disease that appears similar to asthma. It is unclear whether crack effects on the lung persist after stopping because so many cocaine users are also tobacco and/or marijuana smokers. Tobacco and marijuana smokers would be expected to have persistent lung disease even without cocaine use.

Kidney effects:

Cocaine does not directly affect the kidneys, but can cause long-term damage to them because of the effect on blood vessels. Muscles can be damaged by cocaine, releasing a pigment which is toxic to the kidneys.

Stomach and intestines effects:

Cocaine's effects of the gastrointestinal system are also due to indirect effects on blood vessels. Cocaine users get more ulcers, but for different reasons than the usual ulcer patient.

Neuromuscular effects:

If a person does not eat well while high, poor nutrition can cause long-term damage to nerves and muscles.

Infection:

If cocaine is used intravenously (IV drug use) or if cocaine use leads to risky sexual behavior, then the user has an increased chance of getting Viral Hepatitis or HIV. Anyone with these risk factors should get tested. Testing helps prevent the spread of disease and makes early treatment possible.

Head and neck effects:

Snorted cocaine can cause damage to the inside of the nose and sinuses, and to the gums, which persist after stopping use.

Behavior change:

People who have out-of-control drug use (addiction) are cue-conditioned. They crave the drug even after the early withdrawal is over. Craving gets better over time, but you can never count on it being gone forever. It can come back at any time. This craving can be cued by something obvious, like an old using associate offering a rock, something subtle like music or stress, or by something completely out of your awareness. People who have the disease of addiction must be alert for the rest of their lives for the possibility of a craving and develop skills to cope with cravings so they won't relapse back to using. Most people need treatment for a year and a good support system for life to stay off a drug to which they have an addiction.

After stopping cocaine use, the best thing for a person to do to ensure good health is to work a recovery program and stay off all mind-altering substances. As part of their recovery, a person should practice a wellness approach to every aspect of life: social spiritual, and physical. As part of physical health, it is important to eat well, exercise safely and get good health care. Tell your health care provider about your former drug use, so that s/he can be aware of your risks, order appropriate tests to detect hidden conditions, help you heal and/or prevent worsening of any condition you may have acquired.

Bibliography:

Graham, A. et al, Principles of Addiction Medicine, Third Edition, American Society of Addiction Medicine, Inc. Chevy Chase, MD, 2003.

Nnadi, C et al, "Neuropsychiatric Effects of Cocaine Use Disorders"; Journal of the National Medical Association, 97:11, Nov. 2005.

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Response by:

Georgette   Somjen, MD, MS, LPC, CCAS Georgette Somjen, MD, MS, LPC, CCAS
Formerly, Addiction Psychiatry Fellow
School of Medicine
Case Western Reserve University

Christina M Delos Reyes, MD Christina M Delos Reyes, MD
Assistant Professor of Psychiatry
School of Medicine
Case Western Reserve University